Prof. Paul Dendale ,
An Early Appointment to Outpatient Cardiac Rehabilitation at Hospital Discharge Improves Attendance at Orientation: A Randomized, Single-Blind, Controlled Trial Q. R. Pack et al. Circulation 2013; 127: 349-355, published online before print December 18, 2012, doi: 10.1161/CIRCULATIONAHA.112.121996
This study tackles the persistent problem of low physician referral and subsequent low patient attendance to cardiac rehabilitation, which is even more prevalent after PCI than after CABG.In a small randomized trial, the authors showed that an “early” appointment (median of 8,5 days) vs. “usual care” (median of 42 days) after discharge significantly increased participation from 55 to 79% of referred patients. However, this solves only part of the problem, as even in the early group, only 58% attended at least one exercise session (vs. 48% in usual care). A mean of only 18 sessions were followed (vs. 15 in usual care), and only 36% of the early referrals completed the whole program vs. 30% in usual care (non-significant results).The study gave some further insight into the reasons for non-attendance, which were not new: transport, finances, return to work, etc. Thus further measures such as opening the rehabilitation centre during evening hours, reimbursement of rehabilitation and possibly in the future telemonitored home rehabilitation should be explored.In any case, this study clearly shows that starting early after infarction is feasible and might increase attendance. In a non-randomised study we presented at EuroPRevent a few years ago, we could show that late referral results in the same exercise capacity, only later…So let them start early!
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